Abstract

The clinical manifestations of cerebral malaria (CM) are well correlated with underlying
major pathophysiological events occurring during an acute malaria infection, the most
important of which, is the adherence of parasitized erythrocytes to endothelial cells
ultimately leading to sequestration and obstruction of brain capillaries. The consequent
reduction in blood flow, leads to cerebral hypoxia, localized inflammation and release
of neurotoxic molecules and inflammatory cytokines by the endothelium. The pharmacological
regulation of these immunopathological processes by immunomodulatory molecules may
potentially benefit the management of this severe complication. Adjunctive therapy
of CM patients with an appropriate immunomodulatory compound possessing even moderate
anti-malarial activity with the capacity to down regulate excess production of proinflammatory
cytokines and expression of adhesion molecules, could potentially reverse cytoadherence,
improve survival and prevent neurological sequelae. Current major drug discovery programmes
are mainly focused on novel parasite targets and mechanisms of action. However, the
discovery of compounds targeting the host remains a largely unexplored but attractive
area of drug discovery research for the treatment of CM. This review discusses the
properties of the plant immune-modifier curcumin and its potential as an adjunctive
therapy for the management of this complication.